2. O BJECTIVES
List the goals of a bowel and/or bladder training
program
Discuss the preparation factors for establishing a
bowel/bladder training program
Identify the steps involved in implementing a bowel
and/or bladder training program for a person
3. G OALS OF A BOWEL AND / OR
BLADDER TRAINING PROGRAM
Establish a regular pattern of elimination
Decrease number of times a resident is incontinent
Increase resident’s self-esteem by gaining control of
elimination
Decrease range of other problems (such as skin breakdown
from incontinence
Preserve the integrity and function of the elimination
systems
4. P REPARATION FACTORS
E STABLISHING B OWEL
AND / OR B LADDER T RAINING
Past elimination patterns are reviewed, as well as
the entire medical history
Routine for elimination is established by the nurse
and placed into plan of care. All staff must then
carry out the plan
5. S TEPS : B OWEL T RAINING
High-Fiber diet
Daily laxative may be ordered by the physician
Scheduled elimination: place resident on a toilet or commode at
regular, scheduled times
Exercise!
Positive reinforcement
Hydration: 2000 cc daily unless stated otherwise on plan of care
Recorded output
6. S TEPS : B LADDER T RAINING
Supply adequate hydration
Schedule voiding according to plan of care
Toilet or commode instead of bedpan
Promote relaxation and provide privacy during voiding
Use voiding triggering techniques if needed
Record intake and output
Give positive reinforcement
8. O BJECTIVES
Describe characteristics of normal and abnormal elimination
Discuss the effects of aging on the lower intestinal tract
Identify the signs that may indicate constipation
List the measures to help alleviate constipation
Discuss the STNA role in helping to prevent impaction
Describe and demonstrate the care of the person incontinent
of feces
10. F UNCTION
Remove solid waste from the body
Terms used for bowel elimination:
Stool
Feces
Bowel Movement (BM)
11. N ORMAL S TOOL
Brown
Formed
Not necessarily each day
12. A BNORMAL S TOOL
Containing blood, mucous or undigested food
Tarry (black and sticky)
Gray
Liquid
Very dry and hard
No movement for 4 or 5 days
13. E FFECTS
OF
GI tract slows down
Loss of control
Incomplete emptying of rectum
Increased concern regarding bowel movements
Increased risk for intestinal disorders
A GING
14. S IGNS
No record of recent BM
Abdominal distension, flatus
Abdominal discomfort
Agitation and/or irritability
OF
C ONSTIPATION
15. M ETHODS TO P REVENT OR
R ELIEVE C ONSTIPATION
Increased fluids
Diet with bulk and fiber
Exercise
Prompt response to natural urge
16. F ECAL I MPACTION
Hard stool in the lower bowel usually found on exam with
the finger (digital exam)
FYI: Person can have a fecal impaction and have daily
bowel movements
17. S YMPTOMS
No normal stool
Liquid stool seeping from the anus as small amounts of fluid
are able to go around the impacted mass
Constant feeling of need to have a BM
Rectal pain, abdominal discomfort and nausea
18. C AUSES
Decreased muscle tone or nerve block to the lower bowel
Inadequate activity
Inadequate fluid intake
Insufficient bulk in the diet
Uncorrected constipation
19. R OLE
OF THE
Observe
Consistency: firm. formed, liquid, hard?
Note amount
Frequency
Report
Changes in pattern
Person constipated suddenly develops diarrhea
STNA
20. C ARE OF THE I NCONTINENT
Skin care
Assist with toileting as needed
Answer call light promptly
